In memory of Seymour Furman: a Canadian and European perspective

Seymour (Sy) Furman was a challenging and dedicated teacher, a loyal mentor and guide, a colleague and friend throughout our respective professional lives. He was admired and respected both in Canada and in Europe and contributed greatly to our pacing community. The following are some individual reflections. I first met Sy in 1970 as a young staff surgeon at Toronto General Hospital. My chief Wilfred Bigelow (of pacemaker fame) asked me to ‘look after the pacemaker problem’ (unanticipated battery failure, runaway units, fractured leads, erratic follow-up). I had read about an organized pacemaker clinic at Montefiore Hospital and called Sy Furman who immediately invited me to the Bronx, NY, USA. I recall his enthusiasm and willingness to introduce me to the team, to demonstrate the workings of the clinic, the telephone monitoring system, and the data collection mechanism. I returned to Toronto to start a similar clinic with dramatic results in terms of patient safety. Sy had a need to participate and contribute to major meetings and he was both concerned and frustrated about not being involved enough in the organization of the Sixth World Symposium on Cardiac Pacing that was about to be held in Montreal, October 1979. Because I was working closely with Claude Meere, the chairman, Sy kept calling me to stay abreast of progress—he was ultimately most satisfied. He had a sincere desire to promote cardiac pacing and increase physician awareness and involvement. He invited David McGregor, Frank Tyers, and me to be the Canadian founding or original members of NASPE to ensure that this was indeed a truly North American effort, and this proved to be a great stimulus to cardiac pacing in Canada. His commitment to those of us in pacing was total and complete—he appointed me to the Editorial Board of the new journal PACE, which opened a whole new avenue of academic interest for Canadian physicians. This reflected his inclusive approach and eagerness to involve people from around the globe in this new venture. Sy was both stimulating and provocative. He invited me in the early 1970s to participate in the American College of Cardiology programme, Cardiac Pacing, in New York—and to present on atrial pacing. The fact that I had no personal experience was not important—he simply told me to get on with it. His challenge ultimately made me a local expert on atrial-based cardiac pacing. Sy Furman was truly an evangelist concerning pacing and he always responded to our many requests that he visited Toronto to lecture and participate in local conferences: his breadth of knowledge and clinical experience were invaluable and he could comment on any aspect of the field. He was a visionary and anticipated changes in technology and practice. As well, he had tremendous integrity and kept manufacturers on alert with his incisive comments and meticulous data. He invited us at the Toronto General Hospital pacemaker clinic to participate in the Bilitch Report, the surveillance mechanism that kept track of unanticipated failures of different products. He was perhaps the single most important promoter of cardiac pacing in this country. I was Dr Goldman's clinical research nurse in cardiac pacing in 1981 and later nurse manager of the pacemaker clinic at Toronto General Hospital. Sy Furman directly encouraged me and other nurses and technologists to recognize their own vital role within the field of electrophysiology and cardiac pacing—and, in particular, promoted my early involvement in NASPE. CAP, the Council of Associated Professionals, was founded with Sy's encouragement and leadership. His desire for professional excellence within the AP group and his wish to see that organization flourish often led to lively debate. However, once the meeting was finished all was forgotten and he returned to being his warm and charismatic self. Although a true New Yorker, he saw no borders between Canada and the USA and worked with a policy of inclusion that made Canadians and their work completely accepted within his beloved NASPE. He invited me to represent CAP to participate in the NASPExam process. He learned all he could about the Canadian health care system and embraced our clinical and academic contributions within that different economic and social setting. On the numerous occasions that he was the invited guest at Canadian pacing meetings, he infected the audience with his enthusiasm and imparted his knowledge with both patience and constant generosity. He cemented many warm relationships with the majority of pacing physicians and nurse technicians in this country. His warmth, wit, energy, and absent pomposity were welcome to Canadians and changed the way we viewed pacing and ourselves, despite the different practices between Canada and the USA. My first knowledge of Sy Furman was in 1964 during General Surgery residency reading his contributions to the initial World Symposium on Cardiac Pacing in New York. My first personal meeting with him was after he discussed my presentation at the American Association for Thoracic Surgery regarding rechargeable mercury–zinc pacemaker battery. However, our next encounter was not quite so pleasant—we crossed swords over a paper my group had published on our experience with a ball-tip electrode. He was really upset with me about my article entitled ‘The Non-Hermetically Sealed Pacemaker Myth or Navy-Ribacoff 22,000—FDA-Weinberger 0’. He was very supportive of industry problems at that time; later, we came to an agreement and indeed ultimately, he gave us credit for introducing hermetically sealed pacemakers. Our relationship after that continued to grow and flourish. I was a fellow traveller at the founding of NASPE, attended almost every annual session, and truly admired Sy's energy and universality. Although he worked with a number of manufacturers, he was never restrained in public rebuke and at national and international meetings did not hesitate to show engineers and physicians the error of their thinking and presentations. One of the highlights in my career, after returning to an academic position at the University of British Columbia, was convincing Sy to come and spend time as a visiting professor. This was a memorable experience for residents and physicians alike. We later travelled to many international meetings and enjoyed times together with our wives. I was always impressed by Furman's ability to bring meetings back to reality and on track, especially at sessions of the International Cardiac Pacing and Electrophysiology Society. He could be stubborn and argumentative but he could compromise and was respected and admired by all. I recall Sy's commitment to fairness at the World Symposium in Tokyo in 1976 when we Canucks were put into a tour group with him and others, ‘US Pacing Group #1’—he enjoyed the humour of our being lumped with the Yanks and never stopped kidding us about it. He recognized that Canadians pride themselves on not being Americans. My wife and I shared many a subsequent tour at various meetings around the globe with Sy and Eve and became good friends. He always displayed intense interest in his surroundings as well as the local history and politics. Sy pursued his interest in an audio-visual record of the history of cardiac pacing with his usual vigour. I was ultimately able to convince a somewhat suspicious Dr Bigelow that Furman's requests for a personal interview were entirely altruistic. He flew to Toronto at his own expense and stayed with us. The next day, at an informal luncheon at Bigelow's home, with John Callaghan also present, Sy recorded many early anecdotes, and enjoyed Bigelow's precise documentation of the ‘Zoll episode’ (Paul Zoll wrote Bigelow, after learning of his presentation in Boston on an artificial external pacemaker to facilitate rewarming from hypothermia, requesting a visit and the circuit diagram, which he never later acknowledged), part of our Toronto and Canadian pacing history and folklore. Sy was also able to track down Jack Hopps in Florida, the Ottawa-based engineer who had constructed the first pacemaker for Bigelow and Callaghan's laboratory: an example of Sy's perseverance. A few years later, at a NASPE meeting in Toronto, Bigelow came to see Furman's beautiful display on the History of Pacing and was truly impressed by both the event and Sy's commitment to integrity. I had borrowed the original Bigelow–Callaghan–Hopps pacemaker from the archives at Toronto General Hospital for that display. I last saw him at the Hong Kong World Symposium and I was saddened to see how frail he had become. He was a great friend and a constant source of information and assistance to us here in Toronto. Sy Furman's warmth and graciousness was demonstrated to me in 1983 in Vienna's Hoffberg Palace where I gave my first oral presentation. Sy had introduced me as ‘Dr Irwin’ and when I whispered to him that I was not a doctor he moved to within range of the microphone and clearly said ‘that certainly does not matter, my dear, please tell us about your good work…’ From that moment, Sy and I formed a professional and personal connection and a true friendship that lasted for nearly 25 years. He was instrumental, and in part responsible, for the establishment and ongoing involvement of the AP group within the NASPE membership. Throughout the years, he continued to support and recommend AP involvement as session chairs and presenters at North American and international meetings including Cardiostim and the various World Symposia. He ensured that not only AP's but that many Canadians had a presence and involvement. Sy Furman was inexhaustible in his clinical work and exuberant in his clinical research interests. He radiated warmth and he included me in his orbit and encouraged my own growth and involvement in cardiac pacing initially in Toronto and then in Edmonton. He and Eve became dear friends and companions and he welcomed me to his clinic and to his home. His final and most touching tribute came in May 2005 when Sy, obviously honoured and delighted to introduce me, presented the 2005 Heart Rhythm Society Distinguished Service Award. I was deeply moved by his gracious and heartfelt introduction. He is sorely missed and will always be remembered for his commitment and contribution to cardiac pacing in Canada. Sy Furman left an indelible mark on cardiac pacing in Canada. Through his tireless efforts to promote and enhance NASPE, he was responsible for including and stimulating Canadian participation in the annual sessions. He created a level playing field despite the inherent and marked differences in our health care economies and delivery systems. He is remembered with deep affection. Sy was a very influential figure in my development in pacing long before I knew him because of his prolific writing. When working in Chapel Hill, NC, USA for a year, I took a brief opportunity to visit Montefiore Hospital in 1969. I was made very welcome and learned in a few hours the elements of running a modern pacing clinic. This inspired me to take it to Chapel Hill and found a clinic there. Later, whenever meeting Sy he would greet me as a long-lost friend and make me feel for a moment that I was the only person who mattered. Over many years, we met at many meetings; his kindness and academic support were very strong and warm. I treasure a time when we, together with Evelyn, his wonderful wife, were trying to go to a meeting in Dubrovnik in the late 1980s and our flight was cancelled in Zagreb. Sy visited London on many occasions and I always tried to arrange some time together. I was delighted to have hosted both Sy and Evelyn at dinner in my home. Sy was not just one of the founders of Cardiac Pacing but someone who saw it through to the mature state that it now finds itself. He was a truly great teacher and made a contribution to our field that cannot be measured. Included in his qualities was a magnanimity that defines a great man. When I became Editor of the European Journal of Cardiac Pacing and Electrophysiology he supported the effort by writing and reviewing for it. Subsequently, when Europace was mooted he again offered support and encouragement. In Sy we have lost a Father, a brother, and a friend. I feel confident in stating this on behalf of all Europeans in the field who knew him.

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